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Hiatal hernia repair
Definition:
This procedure corrects a defect in the diaphragm (breathing muscle), which separates the chest cavity from the abdominal cavity. A hiatal hernia occurs when the normal opening in the diaphragm is too large. If the defect is not repaired, the stomach or other abdominal contents may bulge (herniate) into the chest, causing heartburn (gastroesophageal reflux) and serious damage to the esophagus. Alternative Names:
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Fundoplication, Anti-reflux surgery Description:
When the opening (hiatus) in the diaphragm is too large, part of the stomach can slip up into the chest cavity. Gastric acid backflows from the stomach into the esophagus, which can cause gastroesophageal reflux (GER). Over many years GER can damage the lining of the esophagus and in some cases may lead to cancer of the esophagus.
For an open hiatal hernia repair, an incision is made in the abdomen while the patient is under general anesthesia. The stomach and lower esophagus are placed back into the abdominal cavity. The hiatus is tightened and the stomach is stitched in position within the abdominal cavity. The upper part of the stomach (fundus) may be wrapped around the esophagus (fundoplication) to reduce reflux. Sometimes the surgeon will place a temporary tube from the stomach through the abdominal wall to keep the stomach in place. In some patients, this operation can also be performed laparoscopically (also known as "keyhole" or "telescopic" surgery). In a laparoscopic fundoplication, small (1 cm) incisions are made in the abdomen, through which instruments and a fiberoptic camera are passed . The laparoscopic procedure is performed using these small instruments while the surgeon watches the image on a video monitor. Laparoscopic fundoplication results in less pain and scarring and shorter hospitalization times than the open procedure but is not suitable for all patients.
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